• Chloe Dunbobbin

How Can Health for All Become a Global Reality?

Updated: Jun 10, 2019


From Left: Dr. Mary-Ann Etiebet, Executive Director of Merck for Mothers; Mr. Pape Gaye, President and CEO, IntraHealth; Dr. Edna Adan, former Foreign Minister of Somaliland; and Dr. Patrick Ndimubanzi, Minister of State in Charge of Primary Healthcare, Rwanadan Ministry of Health speaking at the Maternal and Child Health Forum at the Access Challenge UHC Conference 2018.

Last month, the 72nd Session of the World Health Assembly fostered a renewed spirit of collaboration and partnership to improve global health outcomes. But how can global health actors effectively collaborate? What else is needed to evoke change? To explore this, I looked back on some key insights from discussions with African leaders, global health experts and advocates about how to make health for all a reality.


By Chloe Dunbobbin





“The only way to address any of these challenges we face is the same way we have addressed our work this week – together. The rule of the game is: together.”

- Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation, reflecting on the 72nd World Health Assembly, 20-28 May 2019.


Universal Health Coverage (UHC) is defined by the World Health Organisation (WHO) as ensuring that people and communities have access to the health-care services, medicines, and vaccines that they need, of sufficient quality and without financial hardship. When the Sustainable Development Goals (SDGs) were adopted in 2015, the international community pledged to work relentlessly towards this vision.


The commitment of all 193 UN Member States to the attainment of UHC demonstrated unity, but the need for further collaboration is a challenge that still faces us as we near 2020: a key benchmark in the global targets. After all, the UHC space is many things, but singular is not one of them. It’s a world that intersects with other worlds in ways we never thought possible. UHC must be one of the most boundary-crushing, expansive and interdisciplinary areas of international development that exists. The solutions to overcoming key health challenges must therefore be similarly integrated and cross-sectoral.


This is a realisation GO came to bear after planning, facilitating and later analysing a UHC Conference in New York on the side of UNGA for our client, the Access Challenge. This was a six-month process that immersed us in depths of the UHC space, offering the chance to learn from leading UHC advocates, African leaders, medical professionals and pharmaceutical firms about how we can best achieve the goals outlined by WHO.


Our partners for this conference shared a range of insights, but what stood out was how despite focusing on their respective sectors, including non-communicable diseases, neglected tropical diseases, child health, malaria and maternal health, strong overlaps in their work suggest that solutions to key global health issues can – and should - transcended individual silos.


During discussions, experts recognised the progress achieved as a result of initiatives targeting individual diseases while also exploring synergistic solutions to address concurrent health issues. Vertical initiatives have brought a large amount of funding to the global health space, and have historically generated the momentum for improving health, particularly in low-income countries grappling with endemic disease burdens.[1] To compliment these achievements, many global health leaders now advocate for a focus on integrated primary health care (PHC) that places the needs of people – not diseases – at the heart of health systems. Dr. Asaf Bitton of Ariadne Labs opened our eyes to this approach, introducing the concept of chronicity – the impact on the patient’s lived experience – as an effective lens through which to ensure diseases are treated comprehensively and cost-effectively.


A range of programmes are leading the way in this life course approach to health, including The Zimbabwean Friendship Bench Project supported by Grand Challenges Canada. The Friendship Bench works to deliver mental health care to HIV patients in the waiting rooms of health facilities. By enhancing the overall well-being of HIV patients through community-sensitive therapy, the project has markedly improved HIV treatment outcomes.[2] The success of the Friendship Bench offers a prime example of how patient-focused care can make targeting individual disease areas have a broader, more long-term impact by offering ‘add on’ services to care for a variety of patient needs.


Treating several health issues in tandem also provides an opportunity to secure government buy-in for UHC by deploying funds more resourcefully. The need to invest health funds efficiently is a priority, given that underfunding is a severe impediment to progress, with an estimated US$ 370 billion a year needed to advance UHC by 2030.[3] Many countries, including Ghana and Uganda, need to reduce reliance on private financing methods such as voluntary health insurance and move towards a system that is predominantly public-funded.[4] If returns on investment are evident, governments will be much more willing to provide the political and financial commitment that is crucial to the achievement of UHC.


Despite increases in the mobilisation of domestic resources, the private sector will continue to play a key role in health care provision. Philanthropic donations are a central contribution of the pharmaceutical community and provide the essential commodities without which we could not make UHC a reality. The private sector is often overlooked as a critical partner in improving the health of communities, yet they can offer policymakers extensive experience in the areas of management, capacity building and supply chain logistics. There is a golden opportunity to bring private sector partners on board at the planning stages of health policies, enabling them to collaborate with governments while continuing to innovate outside of government structures.


Dr. Luc Kukyens, Senior Vice President of Global Health Programs at Sanofi, provided us with deeply insightful examples of successful private sector – government cooperation. In 2009, The Drugs for Neglected Diseases Initiative (DNDi) and Sanofi formed a partnership to change the history of sleeping sickness and develop fexinidazole, the first all-oral treatment that works for both stages of the disease. As well as improving product modalities, the partners developed a supply chain system to help ensure the delivery of fexinidazole to communities in DRC.[5] The government retained a key role in this process, but the supply chain was created from the London Declaration to WHO to Médecins Sans Frontières (MSF), who then ships the medicine to DRC. The creation of this supply chain was important in ensuring that medical innovations could be delivered to those who were in need. In this case, service delivery was also considered to truly integrate the new drug into the health system while ensuring the government was cooperative rather than excluded.


Going forward, governments must be continually engaged in UHC. Cost-effective strategies and strong partnerships are effective tools to ensure buy-in from governments globally. My recent meeting with Robert Yates at Chatham House provided a deep insight into the power of engagement with unexpected allies to help ensure UHC is firmly on the political agenda – because there is no financial commitment without political commitment, and vice versa. Political will is the linchpin holding together the wheels of UHC – and they need sustained political commitment to keep moving in the right direction.


If I had to chose just one key takeaway from the lessons shared by experts, it would be that UHC must be about setting a direction and objectives rather than an endpoint. Governments, stakeholders and civic society must work together to improve the health and welfare of their citizens and help to realise UHC. For an affordable dream, political will is everything.


References:

[1] Rao, K.D., Ramani, S., Hazarika, I., George, G. (2014). When do vertical programmes strengthen health systems? A comparative assessment of disease-specific interventions in India, Health Policy and Planning, Volume 29, Issue 4, July 2014, p. 497.


[2] Grand Challenges Canada. (2016). A“Friendship Bench” Program Proves Effective at Alleviating Mental Illness Symptoms. Press release. Available at: http://www.grandchallenges.ca/wp-content/uploads/2016/12/NewsRelease-FriendshipBench-2016Dec27_EN.pdf


[3] Steiner, A., Statement at the Access Challenge – Universal Health Coverage (UHC) Conference. [online], available at: https://www.undp.org/content/undp/en/home/news-centre/speeches/2018/the-access-challenge--universal-health-coverage--uhc--conference.html (accessed 5 June 2019)


[4] World Bank. 2008. The business of health in Africa: partnering with the private sector to improve people's lives (English). International Finance Corporation. Washington, DC: World Bank. Available at: http://documents.worldbank.org/curated/en/878891468002994639/The-business-of-health-in-Africa-partnering-with-the-private-sector-to-improve-peoples-lives


[5] Drugs for Neglected Diseases Initiative (DNDi) & Sanofi. (2018). An innovative partnership to develop fexinidazole: The first all-oral drug for sleeping sickness treatment. Press backgrounder. Unpublished.


#SDGs #UHC #GlobalHealth #Africa #Development #Policies #UNGA #WHA #healthequity #Partnerships #WHO #healthsystems #primaryhealthcare

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